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<chapter num="12" heading="Uniform Consultation Referral" title_num="31" subtitle_num="10">
  <regulation prefix="Regulation" num=".01" heading="Applicability and Scope.">
    <text>This chapter is applicable to all:</text>
    <paragraph num="A.">
      <text>Carriers as defined in Regulation .02B(1) of this chapter;</text>
    </paragraph>
    <paragraph num="B.">
      <text>Consultant/facility providers as defined in Regulation .02B(2) of this chapter; and</text>
    </paragraph>
    <paragraph num="C.">
      <text>Primary or requesting providers as defined in Regulation .02B(4) of this chapter.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Carrier” means:</text>
        <paragraph num="(a)">
          <text>An insurer;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>A nonprofit health service plan;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>A health maintenance organization; or</text>
        </paragraph>
        <paragraph num="(d)">
          <text>A dental plan organization.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>“Consultant/facility provider” means:</text>
        <paragraph num="(a)">
          <text>A person licensed or certified under Health Occupations Article, Annotated Code of Maryland, who receives a referral from a primary or requesting provider; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Hospitals and related institutions that receive a referral from a primary or requesting provider.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>“Hospital” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Primary or requesting provider” means a person licensed or certified under the Health Occupations Article, Annotated Code of Maryland, who refers patients for consultation to a consultant/facility provider.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>“Related institution” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(6)">
        <text>“Uniform consultation referral form” means:</text>
        <paragraph num="(a)">
          <text>For dentists referring patients for dental care procedures or services, the Maryland Uniform Dental Consultation Referral Form or its electronic equivalent shown in Regulation .08 of this chapter; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>For all other health care professionals referring patients for health, medical, or dental care procedures or services, the Maryland Uniform Consultation Referral Form or its electronic equivalent shown in Regulation.06 of this chapter.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Uniform Consultation Referral Form — Carrier Requirements.">
    <paragraph num="A.">
      <text>If a carrier requires a covered person to have a written referral in order to receive services, the carrier shall use the uniform consultation referral form as defined in Regulation .02B(6) of this chapter.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The carrier may not impose as a condition of coverage a requirement to:</text>
      <paragraph num="(1)">
        <text>Modify the uniform consultation referral form, except as provided in §E of this regulation; or</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Submit additional consultation referral forms.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>The carrier may provide a separate set of instructions for properly completing the Uniform Consultation Referral Form.</text>
    </paragraph>
    <paragraph num="D.">
      <text>For the uniform consultation referral form, the carrier’s specific instructions:</text>
      <paragraph num="(1)">
        <text>If applicable, may be preprinted on the back of the uniform consultation referral form, if the instructions do not result in any modifications in the format of, or information categories directed to be supplied on the front of, the uniform consultation referral form; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Shall be made available to primary or requesting providers on the carrier’s website.</text>
      </paragraph>
    </paragraph>
    <paragraph num="E.">
      <text>Notwithstanding the provisions of §B of this regulation, the carrier may provide stamps or preprinted stickers to include additional information to the carrier information block on the uniform consultation referral form.</text>
    </paragraph>
    <paragraph num="F.">
      <text>The carrier may preprint the designated carrier information in the carrier information field on the Maryland uniform consultation referral form.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Uniform Consultation Referral Form — Primary or Requesting Provider.">
    <paragraph num="A.">
      <text>The primary or requesting provider shall use the uniform consultation referral form as defined in Regulation .02B(6) of this chapter and instructions as provided in Regulation .03C of this chapter.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The uniform consultation referral form shall be properly completed by the primary or requesting provider.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Uniform Consultation Referral Form — Consultant/Facility Provider.">
    <text>The consultant/facility provider shall accept a properly completed uniform consultation referral form.</text>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="General Provisions.">
    <paragraph num="A.">
      <text>The requirements under these regulations do not apply to an entity that would be using a consultation form solely for internal purposes.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The Maryland Uniform Consultation Referral Form shall read as follows:</text>
    </paragraph>
    <paragraph num="C.">
      <text>The electronic equivalent of the uniform consultation referral form is as follows:</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".07" heading="Electronic Transfer of the Uniform Consultation Referral Form.">
    <paragraph num="A.">
      <text>A transmission by facsimile is not considered an electronic transfer for the purposes of this chapter.</text>
    </paragraph>
    <paragraph num="B.">
      <text>A carrier shall accept the electronic transfer of the uniform consultation referral form.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".08" heading="Uniform Consultation Referral Form — Required Forms.">
    <paragraph num="A.">
      <text>The Maryland Uniform Dental Consultation Referral Form shall read as follows:</text>
    </paragraph>
    <paragraph num="B.">
      <text>The electronic equivalent of the uniform consultation referral form is as follows:</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Insurance Article, §§2-109 and 15-120, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: October 21, 1996 (23:21 Md. R. 1467)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03 amended as an emergency provision effective January 28, 1997 (24:4 Md. R. 289); adopted permanently effective May 19, 1997 (24:10 Md. R. 710)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07 adopted as an emergency provision effective January 28, 1997 (24:4 Md. R. 289); adopted permanently effective May 19, 1997 (24:10 Md. R. 710)</annotation>
    <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 09.31.23 to COMAR 31.10.12 effective September 7, 1998 (25:18 Md. R. 1439)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective January 1, 2005 (31:23 Md. R. 1655); January 13, 2011 (38:1 Md. R. 12)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03 amended effective January 13, 2011 (38:1 Md. R. 12)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03A amended effective January 1, 2005 (31:23 Md. R. 1655)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04A amended effective January 1, 2005 (31:23 Md. R. 1655)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05 amended effective January 13, 2011 (38:1 Md. R. 12)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .06 amended effective January 13, 2011 (38:1 Md. R. 12)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .06D amended effective January 1, 2005 (31:23 Md. R. 1655)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07 amended effective January 13, 2011 (38:1 Md. R. 12)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .08 adopted effective January 1, 2005 (31:23 Md. R. 1655); January 13, 2011 (38:1 Md. R. 12)</annotation>
  </annotations>
</chapter>